A break-through imaging tool now in use across much of Yale New Haven Health is helping men suspected of having prostate cancer get faster diagnoses with fewer tests. It’s not only more convenient; it can also help fast-track treatments and potentially improve outcomes.
Through international clinical trials, micro-ultrasound has proven to be just as accurate as the more traditional way of looking for prostate cancer – through magnetic resonance imaging (MRI) followed by biopsy.
“This is an outstanding addition to the tools that we can use in the office to better detect prostate cancer,” said Joseph F. Renzulli, MD, director of Urology for Yale New Haven Health’s eastern region, chief of Urology at Westerly Hospital and an associate professor of Urology with Yale School of Medicine. “With this device we can better detect smaller abnormalities within the prostate gland and more accurately direct our biopsies to enhance the pathologic evaluation of the grade and stage of the cancer.”
How is prostate cancer diagnosed?
To understand the benefits of micro-ultrasound requires a brief course in prostate cancer diagnosis. Typically, a high PSA blood test (which measures prostate-specific antigens in the blood) or an abnormal finding during a rectal exam, are telltale signs of prostate cancer. However, doctors need to do more work to confirm the presence of cancer and to then plan a course of treatment.
To sample the prostate tissue and test for cancer, a needle biopsy is required, but a needle biopsy alone to find cancer in the prostate is problematic, Dr. Renzulli explained. “When we sample the prostate with a needle biopsy, we can only sample a small percentage of the prostate, and that means some areas of the prostate will be missed, which means you could miss the cancer.”
To prevent missing a cancer, the standard of care at many medical institutions has long been to require the patient to get an MRI prior to biopsy. “The MRI provides a map of the prostate, and if there are any abnormal regions – regions that are more suspicious for cancer – then we can target those areas at the time of biopsy,” said Joseph Brito, MD, section chief of Urology for L+M Hospital and associate professor of Urology with Yale School of Medicine.
However, “MRI is a procedure that is sometimes difficult for people if they have claustrophobia, it can take weeks to schedule the test, and the test itself requires the patient to be inside the machine for about 45 minutes,” Dr. Renzulli said. “There are also additional costs associated with MRI.”
What is micro-ultrasound?
“Micro-ultrasound is essentially a very high-resolution transrectal ultrasound,” Dr. Brito explained. “It can be used to visualize areas in the prostate that are highly suspicious for cancer – areas that we could not typically see with a standard ultrasound, which is why we used to require patients to get an MRI.”
With micro-ultrasound, patients undergoing the procedure remain awake and receive only a local anesthetic. The images appear in real time on a console monitor to help guide the urologist to perform the biopsy. The procedure takes no more than 15 minutes.
Changing protocols for the diagnoses of cancer, of course, is never done without great care and research. Dr. Brito noted that the micro-ultrasound clinical trial – known as the OPTIMUM Trial -- included more than 800 patients from 20 major medical centers around the world, including Yale New Haven Health.
At YNHHS, nurses were instrumental in making the research possible through timely scheduling and preparation for trial-related procedures, guiding patients through informed consent, maintaining accurate records to support compliance with research protocols, and facilitating seamless communication across multidisciplinary teams.
“The level of engagement we saw in this study really underscores the commitment of our entire team as we try to advance evidence-based practice and improve patient outcomes,” Dr. Brito said. “The trial showed that the micro-ultrasound based approach was equivalent to an MRI guided biopsy in terms of accurately detecting cancer, and that’s a game changer. With equivalent – and possibly even better accuracy – patients are also getting faster care with a more affordable way to detect cancer.”
Yale New Haven Heath remains one of the few organizations in New England currently using micro-ultrasound, with the new test available at Yale New Haven Hospital, Greenwich Hospital and Westerly Hospital in Westerly, RI. Experts believe the technology will rapidly expand across more medical institutions in the coming years.
“We can do the biopsy with micro-ultrasound in one procedure, with no delays or any of the hassles of an MRI,” Dr. Renzulli said. “And the resolution is amazing. A normal ultrasound is 7 to 9 megahertz; with micro-ultrasound, the test performs at 27 to 29 MHz, which is a 300 percent increase in detail as we look at the prostate.”
As more medical centers begin using micro-ultrasound, “I think the hope is that, within the wider population, we’ll see more patients being able to have a higher probability of finding cancer, if it’s there,” Dr. Brito said. “The hope, of course is that finding those cancers earlier allows the patient to get treated earlier, leading to better outcomes in the long term.”
Prostate cancer is the leading cause of cancer in men, with 200,000 cases diagnosed every year. Learn more about prostate cancer screening and micro-ultrasound.
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